Advanced PC and Insurance/Medicare

When I retire eventually, Medicare will be my primary insurance and BC/BS will be secondary. I am not sure what BC/BS will even cover on that.

So, how good is Medicare in terms of coverage of tests/drugs/etc.

Mel

I have Medicare and BC/BC in Massachusetts.

Treatments to date RRP, Radiation with 6 months ADT2.
Multiple cat scans, prostascint scan, xrays, ekg's, extensive blood tests.
Currently on clinical trial.

No costs for these

Only pay a copay for drugs.

Carlos:

It gets real tricky. My understanding is that right now, Medicare will be secondary to my insurance. That's not the same as a supplement. So say a doctor charge $1000 and Medicare would normally pay $600. If my regular insurance pays $600, then that's it. Medicare considers that bill paid, albeit by my other insurance (a supplement would look at the difference and pay a percentage of that).

When I go to MediCare being the primary and BC/BS being the secondary, I think it's the same thing. They are not a suppleement. I'm not totally sure.

Mel

I was unable to find any physician who was willing to accept new Medicare patients..Their advise, if you are sick, go to the ER, they take Medicare..My family doctor recommended I investigate Medicare Advantage, a type of Medicare managed by private insurance companies the doctors find more acceptable...Depending on how much you are willing to pay, different plans are available. In your 64th year, the offers come pouring in..Tons of it..

Medicare does a pretty good job of paying for things, the co-pays are reasonable..Except when it comes to radiation treatment, where they generally only pay 80% of the treatment cost leaving you to pick up the rest..This can be serious money..You can protect yourself from payment shocks by asking the provider get pre-approval from your insurance first...

My husband has Medicare as his primary insurance and BC/BS as his secondary.   Although he is not 65 yet, he has coverage because of his spinal cord  injury disability.   He had sepsis following the prostate biopsy and was hospitalized for a week.   He was in the hospital another full week following his prostate surgery because of complications.   Medicare and Blue Cross covered all costs.  

Mel,
I'm on medicare, I signed up for medicare oartr A & B with medicare supplement part "F". So far, through my treatment it has covered everything. I haven't had to pay any co-pay to doctors, labs or hospitals.

I'm on Medicare primary and Tricare secondary. When I inquired from a couple of well known national PC urologists about doing robotic surgery, they did not accept Medicare. But I found several excellent local doctors in the DC area that did, so I had my DaVinci paid for with Medicare, and whatever they did not cover was picked up by Tricare. I don't remember how much I was out of pocket, but it was minimal, maybe a couple of hundred at the most, compared with the $15-20,000 cost of the surgery and hospital. From what I recall, though, Medicare only actually pays a small percentage of that, per agreements they make with doctors. The issue is, especially with the cuts we're seeing, that fewer doctors and hospitals are taking Medicare.

At one time I thought, if a doctor doesn't take Medicare because the reimbursement is too low, can I agree to pay out of pocket for the difference? For example, if a procedure costs $10k but Medicare only pays $6k can I agree to pay the doc the $4k out of pocket, instead of the entire $10k? The answer, as I found out, is no. If a doctor won't take Medicare they are not allowed to recover the difference from the patient.

James, I just completed  SRT and this is how Medicare worked for me.  Radiologist billed Medicare $82,000 for my comlete treatment.  Medicare's total approved benefit for my treatment was $32,000.  So, Medicare Part B paid $25,600 (80%) and I and my supplemental policy were responsible for the remaining $6,400.  I have a Medicare supplemental plan J and it paid the entire $6,400 (20%).

Carlos

Wow -- a whole new area of confusing games to play.

With my work plan, I think my OOP (out of pocket) maximum is $1000 in-netowrk, so I'm not too worried about my cost.

Again, I suspect it will be much less, if anything, because they are in-network.

I'm not worried about the cost. There is no question I NEED to do the SRT. It is not an option!!

My set-up is tomorrow.

Mel

You need to be careful when on medicare. Medicare Advantage is low in cost but you are restricted to the doctors and hospitals on their plan. Most reputable doctors and hospitals do not accept medicare Advantage. Medicare supplement is costlier but is accepted by all doctors who accept medicare.

Fairwind said...
Carlos makes some good points and points out the major weakness in how health-care is provided in the U.S.

If you are uninsured or self-insured, his doctor expects to be paid $82,000 for the SRT. But this same doctor is willing to accept $32,000 from Medicare plus $6400 from whoever they can get it from...

Radiation Oncologists earn, on average, over a half-million dollars a year....

My Medicare Advantage Secure Horizons ARRP plan, by United Health-Care, is fairly low cost (zero cost actually) insurance that is similar to an HMO in structure. I must be treated in my Denver "group", a large selection of doctors, specialists, hospitals and treatment centers.. I must get referrals from my primary care physician to see specialists (he is very obliging) and while ER visits are covered anywhere, if I need treatment for chronic conditions I must get that treatment in Denver or pay for it myself..Once a year, in November, you can change plans and upgrade the services available but these upgrades can cost serious money..The top-of-the-line plan that covers everything, everywhere, anytime runs about $600 / month extra....(I think)..

United Healthcare also owned and operated Pacificare in Colorado. I forgot when they bought it but I was a member of it for over 20 years. Pacificare was an HMO but was accepted by most doctors. I was able to reject TUCC care and opt for CU Med Ctr where they paid for my TFT. They only balked initially at the 3D saturation biopsy. So I had no complaints with them at all. But in 2009 they moved Pacifcare out of Colorado and tried to replace it with a united health care plan that by looking at it was much inferior. I'm a retired federal worker and the only HMO plan left now is Kaiser which I wouldn't enroll my dog in. Now I'm on BCBS It's a little cheaper but I rather have Pacificare back